Beware “alternative” medicine

I don’t like the phrase “alternative medicine.”

Medicine, as I see it, ought to mean “something that treats or prevents disease.” It should encompass all modalities and methods that can be shown with reasonable certainty to be effective. Whether it’s a drug developed through the research of a pharmaceutical company, a device invented in someone’s garage, an herb that’s been used for thousands of years, or a physical manipulation technique, all medical treatments should be held to the same standard: good, reproducible, and reliable scientific study should show that the method works. Research should also be used to determine what side effects and risks are likely from the treatment, so doctors and patients can judge the risks versus the benefits to determine if using the method is a good idea.

If the treatment meets this criteria—that is, it can be shown to be effective, and its risks are justified by its benefits—then it should be called, simply, “medicine.” It shouldn’t matter whether it’s from the realm of what some people think of as “traditional medicine” or from the realm of “alternative medicine.” If it works, it’s medicine. If it’s not known whether it works because good studies haven’t been done, a good term for it is “unproven medicine.” If good studies have shown that the treatment is ineffective, the best term I can think of would be “quackery.”

The best, most reliable evidence to prove that a treatment is effective is from a well-designed, randomized clinical trial. One good example of such a study is from 2007, when researchers tried to see if honey was an effective treatment for cough. They enrolled a group of about 100 children with ordinary coughs into the study, and with the parent’s permission randomized the kids into one of three groups. Each group got one of three syringes filled with a potential cough treatment. One contained honey, one contained a standard cough medicine, and one was actually empty (no treatment). The honey was thickened and flavored so it tasted like cough medicine, so the parents and kids couldn’t tell which one they’ve tried. The next day, researchers called the families and asked if the cough had improved.

Why all of the deception with the secret treatments? That’s an essential step. Almost all health conditions will improve on their own, without treatment. Just because a patient took something and got better doesn’t mean that the something actually worked. Maybe the patient would have gotten better anyway. There’s also some strong psychology at work: when we do something that we expect will help us feel better, it does help us feel better. Symptoms like cough or pain or nasal congestion are all subjective. To really prove that a treatment works, it should be shown to be more effective than doing nothing. After all, why should patients accept the expense and risk of a treatment if it doesn’t really do anything more than plain water or a sugar pill?

Science-based medicine is a process that develops and improves with time. As better studies are done and more information is available, some treatments that were once thought to be effective are abandoned in favor of better treatments. Doctors should strive to offer the best and safest available treatments, based on the best scientific information available.

There are several treatments from what’s often called the realm of “alternative medicine” that have passed the tests of science and belong firmly in the treatment toolbox of physicians. These include probiotics for a variety of illnesses, omega-3 supplements for the prevention of heart disease, and melatonin to regulate sleep cycles. I don’t consider these “alternative medicine” at all—they’re just medicines, and have their own well-understood risks and benefits.

That cough study was actually done, and showed that the honey was at least as good as cough medicine at treating cough, maybe even a little better. Based on this and similar studies, we know that cough and cold “medicines” are nearly worthless, and aren’t worth the expense and risks. Good science has shown us that some treatments from the realm of traditional medicine—in this case, cough suppressants—belong in the “quackery” category. The same good science has shown us that something you might have thought of as an alternative medicine—honey—belongs in the realm of “real” medicine.

My main problem with alternative medicine is that its proponents do not share my conviction that these products need to be tested and evaluated. The world of alternative medicine seems to be littered with all sorts of goofy treatments and modalities that haven’t withstood even a whiff of scientific scrutiny. Their proponents seem very reluctant to point any fingers and say “that doesn’t work.” I’m not sure I’ve ever run across any criticism of any alternative medicine modality from any alternative medicine proponent. In the world of alternative medicine, it’s “anything goes.” This makes it very difficult to know what actually works.

In addition, there is very little oversight or regulation of alternative medicine treatments. Supplements and herbs are a billion-plus industry in the United States and other than voluntary industry programs there is no regulatory authority that ensures that what’s on the label is what’s in the bottle. There have been many cases of poisonous substances contaminating herbal products, and there’s no way to know if the product was manufactured, stored, or labeled properly. Just about anyone can call themselves a “natural” practitioner, giving advice and selling products.

A good starting point to read about “alternative health” is http://www.quackwatch.com/. Along with several sister-sites, Quackwatch does an excellent job in bringing the light of science to the murky world of alternative medicine. The articles are reliable, honest, and well-referenced.

4 Comments on “Beware “alternative” medicine”

I agree that all treatments, traditional or alternative, should be held to a similar standard of effectiveness.

But as with many things, it all comes down to money and legislation. Drug companies with a patent on their latest drug have a financial incentive to fund rigorous studies (not to mention that they are legally mandated to do so before they can sell their drug). No one has any incentive to rigorously study, say, rosemary extract. No company wants to fund this, because other companies will reap just as much benefit. And how many grants are available for these sorts of studies?

Enough studies have been done to show melatonin does something, but is anyone funding studies to pinpoint effective doses? Maximum safe doses? Interactions with other medicines? The effect of melatonin on people outside of the range of initial studies, such as kids, or seniors? And with no regulation, is there any way to know that melatonin pills actually contain what they say? It’s rather frustrating that our country’s regulatory framework and funding of medical research isn’t set up in way to address these issues.

And as long as these issues remain, alternative medicine practioners will justifiably be able to point to their quack therapies and say, “This works, but no one wants to pay money to prove it.”

Alternative health is a huge business– this author from the Wall Street Journal says 4 billion in sales in the United States alone. There is also a division of the National Institutes of Health devoted to funding alternative medicine studies, though they have not been able to spend their entire budget because of a shortage of applications for high-quality studies. There is plenty of money for alternative medicine studies available. But there is a cultural difference: the alternative medicine crowd by and large remains disdainful of good quality studies. They know many people can be fooled by unreferenced testimonials, and can use these to drive their sales.

First off, thanks Dr. Roy for a stimulating article! It’s been awhile since I thought about this aspect of medicine and always appreciate your perspective.

Practitioners of medicine around the world face a serious challenge in bringing “alternative” and Western medicine together. Many people around the world do not have the same belief in Enlightenment era science that we do in the U.S.. Medicine, much like the food that we eat, is greatly influenced by our culture, and what we believe to be real, true and meaningful. “Quackery” is real in every culture, and many people are out there exploiting others with fraudulent medical “treatments.” But just as real is a large insensitivity to the non-western world-views of others who believe not in Western science but see the other world in different ways. Not only do we need to find a way to bring effective traditional medicine to the western scientific and medical communities, but we also need to find ways to communicate western science and medicine effectively to communities who see the world differently. We need to find ways of merging Western and other medicines in ways that improve patients lives without forcing them to abandon their belief systems.

I could write on this for hours, because I think there is some place where learning from other belief systems requires abandoning our own, if only for a moment in order to truly empathize with the experience of the other. But there is certainly an area of this discussion with many many dark sides (as your writings on vaccination-science-denialism has shown time and again).